We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.

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Wednesday, March 1. 2017

1. The U.S. leads the world in health care spending per person, but not in health care outcomes. Many people look at that and say that health care costs too much in the U.S., and we should be able to get the same or better outcomes by spending less. Maybe that is correct, maybe not. That is not the point here. But–

2. the U.S. leads the world in K-12 education spending per student, but not in student outcomes. Yet nobody says that education costs too much and that we should spend less. Except –

The difference between health care spending and education spending is one of expansion: the possible number of medical treatments is continually increasing, whereas the possible amount of education is not - for example, they are now developing a way to put people into suspended animation after suffering major trauma:

That's amazing! We, as a species, have never done anything like this before. Of course it's going to cost money, especially at first. However this is a brand new treatment and will be used to save people who previously could not be saved.

(And as someone who used to work in public health, I can tell you that almost all of those "worse than the rest of the world" health outcomes are due to the ethnic diversity in the United States. Notice that the Europeans crow way less than they used to about those numbers...)

However, all you can get in education is a PhD - the same as 50 years ago. There is no new thing in education, nothing is expanding - unless you count online education which should be making things cheaper because of economies of scale. Administrators are the only expense that is increasing in education, and they provide almost no value.

Medical care is a product with infinitely expandable demand. The only way to control cost is to do what the French do, or would if their economy was better. The French system provides a minimum level of care for everyone who is a member (It is funded by payroll but has a large welfare group). Then the members are free to spend as much as they want on better service. Doctors are encouraged to accept the health plan payment with pensions and vacations funded. Medical school is free. However, there is still a free market for those who want it. It has the highest satisfaction level in Europe.

You silly Americans still don't understand that you spend so much money on this stuff because ....

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you have it, you're wealthy, you can use thousand dollar bills to light your cigars.

The rest of the world, especially the commies, are too stupid to understand the real consequences of productivity and wealth.

And don't start with this American exceptionalism, shining city on the hill stuff, you lucked into a part of the world so rich in resources and climate that only native American Indians could screw it up.

In the past, those with lots of schooling often, at least those who left academic works behind, were ended up educated. However, all the schooling or credentials in the world does not mean one is educated.

As to lucking in to resources, the USSR, China, Australia and most of Africa has about the same distribution of resources.

American Exceptionalism is in our form of governance, or at least it was.

It used to be that the government didn't much get in your way until you hurt someone, or got big enough that it was a fair fight.

Now you can't even drain a puddle in your back yard if there is a creek with running water somewhere in your area code.

The reason our health outcomes are not up to European Standards is that lots of Americans don't do what *anyone*, including doctors, tells them to do unless it's dumber than dirt (like get a copper bracelet to cure arthritis).

And ditto with healthcare. The bulk of the money goes not towards treatment or even effective diagnostics, but to paying off lawyers and the feel-good but useless diagnostics procedures performed for no other reason than to hopefully prevent being sued for malpractice if you didn't find that extremely rare thing that the patient didn't even come to you for in the first place.

The entire story around our health outcomes are a classic example of how statistics lie and obfuscate. If you throw out the outliers; tiny countries and countries where good data doesn't exist or their government intentionally misrepresented the data to make them look better you are left with a couple of countries that have good health outcomes to compare with the U.S. Most notably Japan and you could even include Canada although the sample size is so much smaller. First it is important to point out that the differences between those countries that statistically have good health outcomes is tiny when compared with the U.S. But that aside in Japan senior citizens live longer. So why? Better health care, better genes, why? Most probably because of cultural differences in that Japanese elders are revered and generally are cared for by their children and this is a better system then nursing homes. Simple as that.

But the real issue is a statistical anomaly where the U.S. has millions and millions of people living here who grew up in 3rd world countries and have health issues that were contracted in childhood. Also the U.S. is a diverse country with 10's of millions of people from races/ethnicities that have genetic health issues that have very little to do with good or bad health care. If Japan or Canada had these diverse communities their outcomes would be worse than ours. In fact these studies have been do where the U.S. population was evaluated but leaving out a handful of major cities with large ethnic populations and the result is that the U.S. outcomes are better than Japan and Canada.

I believe that what is really going on is that special interest groups who want to increase funding or change specific emphasis in health care are using these inaccurate statistical studies to push for changes that won't make our health care better but will satisfy certain agendas. Just the old fashioned misinformation campaign to extract goodies for one group at the expense of another group.

You are absolutely correct. My local school system and others I have looked at have more "administrators" than teachers -- even if you throw in teacher's assistants, however that works out. So the "per pupil" expense is just a way of spreading the manure a little thinner. It doesn't get to the actual students.

Organizations like Doctors Without Borders that try to help really impoverished people on limited budgets sometimes do a good job of thinking through which medical interventions give us bang for the buck, like instant-read diagnostic devices that prevent a patient from having to make a difficult and expensive followup round-trip to a clinic. This is the kind of thing a free market is supposed to be good at when it's allowed to do its usual job of efficiently allocating scarce resources.

I'd like to see K-12 schools exposed to the same competitive pressure, if we can crack the monopoly wide open.

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